November midterm elections bring high stakes for Medicaid
WASHINGTON — The midterm elections could bring sweeping changes to Medicaid, from possible eligibility expansions to new rules requiring low-income people to work, depending on voters’ choices for governors’ offices and state legislatures across the country.
Medicaid covers more people than any other federally funded health program.
Medicaid expansion advocates are optimistic that voters in Idaho, Nebraska and Utah will pass ballot initiatives to broaden coverage, buoyed by strong polling numbers and the fact that petitions in those states to force ballot votes garnered tens of thousands of more signatures than needed. Experts say other states, such as Kansas and Georgia, could expand eligibility, depending on the electoral outcomes, especially if conservative priorities such as work requirements are added.
Uncertainty around the future of Medicaid expansion emerged in recent years because of court challenges and Republican efforts to repeal the 2010 health care law, but states that put their expansion discussions on hold are now revisiting their thinking, said Ben Sommers, associate professor of health policy and economics at Harvard University.
“States are going to be back in this game, and we may see the steady trickle (of expansions) resume,” Sommers said.
If approved by voters, expansions in Idaho, Nebraska, and Utah would extend health insurance to more than 300,000 low-income people. Meanwhile, in Montana, another ballot initiative, if approved, would renew the state’s existing expansion, which covers nearly 100,000 people though it expires next year.
It’s possible that Florida and Missouri could hold expansion ballot initiatives in 2020, said Kelly Hall, director of health policy and partnerships at The Fairness Project, a group promoting ballot initiatives.
But experts note that a vote for expansion by ballot initiative doesn’t necessarily mean an easy path forward if state officials balk. Take the case of Maine, where Republican Gov. Paul R. LePage refused to implement expansion after nearly 60 percent of voters passed an expansion ballot initiative in 2017. The state Supreme Court ordered him this summer to move forward.